EP2179761B1 - Tube trachéen - Google Patents

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Publication number
EP2179761B1
EP2179761B1 EP09013244A EP09013244A EP2179761B1 EP 2179761 B1 EP2179761 B1 EP 2179761B1 EP 09013244 A EP09013244 A EP 09013244A EP 09013244 A EP09013244 A EP 09013244A EP 2179761 B1 EP2179761 B1 EP 2179761B1
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EP
European Patent Office
Prior art keywords
tube
gasket
trachea
sealing sleeve
respiratory
Prior art date
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Active
Application number
EP09013244A
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German (de)
English (en)
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EP2179761A1 (fr
Inventor
Dieter Prof. Dr. Köhler
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Willy Ruesch GmbH
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Willy Ruesch GmbH
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Publication date
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Publication of EP2179761A1 publication Critical patent/EP2179761A1/fr
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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/04—Tracheal tubes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/04—Tracheal tubes
    • A61M16/0434—Cuffs
    • A61M16/045—Cuffs with cuffs partially or completely inflated by the respiratory gas
    • A61M16/0452—Cuffs with cuffs partially or completely inflated by the respiratory gas following the inspiration and expiration pressure
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/04—Tracheal tubes
    • A61M16/0465—Tracheostomy tubes; Devices for performing a tracheostomy; Accessories therefor, e.g. masks, filters
    • A61M16/0468—Tracheostomy tubes; Devices for performing a tracheostomy; Accessories therefor, e.g. masks, filters with valves at the proximal end limiting exhalation, e.g. during speaking or coughing
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/04—Tracheal tubes
    • A61M16/0475—Tracheal tubes having openings in the tube
    • A61M16/0477—Tracheal tubes having openings in the tube with incorporated means for delivering or removing fluids
    • A61M16/0479—Tracheal tubes having openings in the tube with incorporated means for delivering or removing fluids above the cuff, e.g. giving access to the upper trachea
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/04—Tracheal tubes
    • A61M16/0434—Cuffs
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/04—Tracheal tubes
    • A61M16/0488—Mouthpieces; Means for guiding, securing or introducing the tubes
    • A61M16/0497—Tube stabilizer

Definitions

  • the invention relates to a tracheal tube for ventilating patients by means of a pressure-controlled respirator with a breathing tube, which is at least partially insertable into the trachea, with a sealing cuff, which is arranged on the insertable into the trachea part around the breathing tube around, with at least one Ventilation cannula, which opens into the gasket and with a suction device.
  • Tracheal tubes for ventilating patients with inadequate or exhausted breathing are known in the art in a variety of forms and designs and serve to deliver respiratory gas into the lungs of a patient.
  • the tube is introduced into the trachea (trachea) of the patient endotracheal or tracheostomatically.
  • a gasket cuff
  • the gasket is not inserted in the inflated state in the trachea, but only filled with air as soon as the breathing tube is in its intended position.
  • the gaskets of such Tracheltubusse are oval or spherical.
  • the inflated gasket causes the respiratory gas to penetrate into the lower airways to ensure adequate patient oxygenation.
  • the gasketing cuff prevents aspiration of fluids flowing back from the pharynx and oral cavity, which can lead to serious complications when entering the lungs, e.g. an aspiration pneumonia.
  • the gasket is filled with gas independently of the ventilation air, and also the pressure during inflation of the gasket is independent of the pressure of respiratory gas inspired into the patient's lungs.
  • Such inflated seal cuff then presses against the inner walls of the trachea constantly for a continuous seal between the breathing tube and the trachea. Even if the inflation pressure of the gasket is limited to the lowest possible level for a sufficient seal, the pressure of the gasket against the walls of the trachea is traumatic.
  • tracheal tube Especially with a long-term use of a tracheal tube causes the pressure on the trachea and the associated circulatory disorders Gewebsnekrosen, tracheal stenoses or Druckulceras, which require as well as remaining scars in the gasket cuff serious and lengthy retreatment and can lead to lifelong respiratory insufficiency.
  • the secretions and secretions accumulating in the subglottic region of the trachea In order to seal against aspiration, the secretions and secretions accumulating in the subglottic region of the trachea, the area of the trachea between the cuff of the tracheal tube and the vocal cords, must be aspirated as required by means of a catheter, usually orally inserted.
  • tracheal tubes with a guided parallel to the breathing tube suction catheter, for example, the Tubusse from DE 44 45 428 C1 and the DE 195 33 615 C1 with which the subglottic secretions and secretions can be extracted if necessary.
  • the secretion or retention of secretion in the trachea should be avoided as far as possible.
  • the respiratory breathing gas is usually humidified and warmed.
  • the secretion of respiratory air in the bronchial area keeps the secretion fluid as fluid as possible, so that the secretion can be led out in part during expiration with the flow of air.
  • Secretion which accumulates in the lung of the pressure cuff in the trachea and the breathing tube, must be placed in the breathing tube via special be aspirated suction aspirate to reduce the risk of infection. This regular bronchial toilet is perceived by the patients as unpleasant and stressful.
  • Such tracheal tubes are usually only suitable for use with volume controlled respirators, which today are almost completely displaced by the superior pressure controlled respirators.
  • sealing by the gasket only acts cyclically, after inflation of the gasket during inspiration of the respiratory gas into the lungs, a seal is made which altogether avoids the return of the respiratory gas orally. Collapse of the pressure cuff is prevented by a special geometry of the inlet openings (into the gasket) through the wall of the breathing tube or by suitable valve means.
  • Another tracheal tube with a vented gasket shows the EP 1 329 239 A1 wherein the gasket is connected through a slot in the breathing tube to the interior of the breathing tube.
  • the publication EP 640 355 B1 describes a development of such a tracheal tube with open gasket in which the gasket itself or a second, the gasket surrounding the pressure chamber is connected by a capillary directly to the respirator. Also the publication WO 2005/009522 A1 discloses a tracheal tube with an open gasket connected to the respirator via a cannula in the wall of the breathing tube and inflated and relieved to the rhythm of the patient's breathing.
  • a tracheal tube with an open to the breathing tube sealing sleeve describes the DD 68 597 .
  • This tracheal tube is provided with a separate suction channel.
  • the gasket located at the end of that channel is inflated because a portion of the respiratory gas is forced through multiple apertures through the gasket, the apertures being spaced by a constriction in the breathing tube.
  • This constriction also causes inflation of the gasket and exposition to the walls of the trachea during expiration via the breathing tube. Air and secretions can be sucked out of the subglottic area at the same time during expiration or at desired intervals via the suction channel.
  • Tracheal tubes with gaskets open to the breathing tube require the increased pressure of volume controlled respirators to inflate the cuff. In the inflated state of the gasket, this pressure is then applied to the trachea and leads to traumatic damage, although the cuff only bears against the trachea during inspiration with high pressure. Also, in simple embodiments, the risk of aspiration continues to exist.
  • a tracheal tube shows the EP 152 694 B1 .
  • the gasket is applied in a conventional manner with a pressure which achieves a seal against the walls at the lowest extent of the trachea, whereby a seal against the tracheal wall is ensured even during exhalation and aspiration is prevented.
  • This gasket is surrounded by another balloon which is either also gas filled under a pre-pressure or which may be filled with respiratory gas via a separate conduit during inspiration to seal the inspiratory expansive trachea in accordance with the breathing rate.
  • This form of tracheal tube allows a permanent seal against the wall of the trachea and thus prevents aspiration, even with the slightest extension of the trachea during expiration, a constant pressure on the walls of the trachea is exercised. Although this pressure is adapted to the particular extent of the trachea, the walls of the trachea continue to be loaded despite the complex structural design.
  • the publication WO 86/002564 A1 describes another tracheal tube with a gasket for a continuous seal between the breathing tube and the trachea.
  • a first respiratory canal is in this Tracheal tube in parallel provided a second voice channel, which is connected to a voice generator and feeds a series of holes in the wall of the breathing tube to the throat of the patient sounds for talking.
  • the object of the present invention is therefore to provide a simple tracheal tube, which avoids the problems known in the art, in particular traumatic pressure damage to the trachea and the risk of infection.
  • a generic tracheal tube in which the at least one vent cannula opens with its end facing away from the gasket in the breathing tube, wherein the jacket sealing surface of the gasket is greater than the lungs ⁇ rtige annular end face of the gasket and the suction preferably arranged sucking in the orbital cervix is.
  • a voice valve is provided, wherein the voice valve is arranged on the not insertable into the trachea part of the breathing tube and the at least one ventilation cannula on the side facing away from the gasket cuff of the speech valve opens into the breathing tube.
  • Such a tracheal tube according to the invention can be used in respectively suitable embodiments both as an endotracheal tube and for use in a tracheostoma, the part of the breathing tube which can be introduced into the trachea being introduced either orally or via the tracheostoma.
  • the pressure with which the gasket inflates during inspiration after a short delay corresponds to the pressure of the respiratory air provided by the respirator.
  • inspiration all of the respiratory gas is supplied to the patient via the breathing tube, during exhalation a portion of the breathing air can be exhaled orally past the gasket as the gasket of the tracheal tube of the present invention pulsates at the rate of pressure-controlled ventilation.
  • the breathing tube is understood to be the entire structure connecting the respirator to the patient's lungs.
  • the inflated during inspiration and applied to the wall of the trachea sealing balloon collapses after the onset of expiration at least partially.
  • the collapse of the gasket, after the end of inspiration is first initiated by the pressure drop in the breathing tube and in the fluidly directly connected gasket, the breathing air flowing back through the breathing tube during expiration through the venting cannula drawing air from the gasket.
  • the pressure of the respiratory air in the lungs against the annular face of the gasket supports collapse or partial collapse of the gasket.
  • a portion of the expiratory airflow past the gasket may be exhaled orally through the trachea, further assisting collapse of the gasket.
  • the portion of the expiratory airflow passing orally past the gasket may produce bronchial secretions Passing the gasket, but may also transport other fluids present in the subglottic area of the trachea, orally. Since inspiration from the respiratory gas occurs exclusively through the breathing tube, the risk of backflow of bronchial secretions and aspiration is low.
  • the pulsation or ventilation of the gasket in the tracheal tube here thus not only counteracts traumatic pressure damage to the trachea, but also reduces the risk of infection and aspiration through bronchial secretions, as this exhales from the lower part of the trachea past the gasket cervix orally is transported while the inspiration takes place exclusively on the breathing tube.
  • the voice valve prevents exhalation by a valve mechanism, the escape of breathing air through the breathing tube.
  • the inspiratory air supplied during the inspiration can thus be passed completely through the vocal cords during the expiration of the voice.
  • Speech valves are used in particular for strengthening the respiratory muscles, for therapeutic spontaneous breathing at regular intervals and for weaning from the respirator after long-term ventilation.
  • An incorrect arrangement of the speech valve beyond the connection of the ventilation cannula to the breathing tube can lead to a condition in which the patient can inhale or respire, but can not exhale, which initially leads to hyperinflation of the lungs and shortness of breath with panic states but ultimately can lead to the death of the patient.
  • a bypass can be provided on the voice valve, which ensures the venting of the gasket via a connection to the ventilation cannula.
  • the jacket sealing surface of the gasket is the part of the outer wall of the gasket that rests against the wall of the trachea when inflated and at the inspiration achieved a sealing of the breathing tube to the trachea.
  • the jacket sealing surface must be larger than the lungs ⁇ rtige annular end face between the breathing tube and trachea, otherwise the pressure equalization produced by the vent cannula, or the pressure balance between the gasket and the lungs would lead to a detachment of the jacket sealing surface of the trachea. As a result, part of the respiratory gas which has flowed in during inspiration can then escape orally past the sealing collar.
  • the necessary interaction between the gasket and the aeration cannula and the breathing tube and the air flow therein is coordinated so that the pressure builds up in the gasket during inspiration without delay and degrades so far and so quickly in the expiration to a part of the expiratory airflow along with bronchial secretion to the orifice around.
  • the patients intubated with a tracheal tube according to the invention can speak during the expiration since the orally exhaled respiratory air flow also flows past the vocal cords. This is perceived by the intubated patients as very pleasant, as the nursing staff easier needs and wishes can be communicated.
  • the part of the respiratory flow which is directed orally in the case of expiration reduces the risk of aspiration, since the orally directed air flow on the one hand already reduces the backflow of fluids from the pharynx into the trachea and, on the other hand, at least partially removes fluids located in the trachea.
  • the pulsation of the gasket allows the transport of bronchial secretions from the lower part of the trachea to the gasket over into the subglottic region, which is why it is no longer necessary in the inventive tracheal tube to reduce the secretion production of intubated patients, for example by a strong moistening and Preheat the respiratory gas or medication. Ventilation of the gasket thus promotes bronchial secretion into the subglottic region of the trachea.
  • the suction device of the tracheal tube sucked up orally in the direction of the gasket makes it possible to suck off this secretion.
  • the emergence and the orrace Transport of secretions not avoided, or only at the moment of extraction are allowed, but is fully possible.
  • An expedient embodiment provides that the inner wall of the sealing sleeve arranged around the respiratory tube completely rests against the respiratory tube or is formed by the respiratory tube.
  • Such an embodiment of the inner wall of the gasket allows a simple cost-effective design and at the same time avoids hygienic problems and infections that may be caused by a deposit or accumulation of secretions.
  • the volume of the gasket between the breathing tube and the lateral surface can be undivided.
  • the design of the gasket with only a single undivided air-filled chamber allows safe ventilation of the gasket so that the collapse or partial collapse of the gasket during expiration creates a sufficient gap between the trachea and the gasket.
  • a sufficient partial respiratory air flow for the oral secretion transport is then provided.
  • the undivided volume of the gasket thus makes it possible to optimally implement the functional principle of the gasket.
  • a further embodiment provides that the gasket in the part insertable into the trachea is closed relative to the breathing tube, i. is formed opening.
  • Such a fluid-tight closed design of the gasket prevents secretion or deposits in openings or cavities and therefore also reduces the risk of infection for intubated patients.
  • the gasket can be cylindrical.
  • a substantially cylindrically shaped gasket has with typical dimensions relative to the annular end faces between the breathing tube and the lateral surface on a relatively large jacket sealing surface, as in a cylindrical gasket a larger part of the outer surface can create the wall of the trachea than in conventional spherical or oval gaskets is possible.
  • the jacket sealing surface is arranged at the same radial distance to the breathing tube, so that the breathing tube extends substantially centrally through the sealing sleeve. Due to the uniform distance of the jacket sealing surface to the breathing tube is not only a uniform concern of the jacket sealing surface on the wall of the Trachea but also achieved a centering of the lung end of the breathing tube in the trachea.
  • the largest outer diameter of the cylindrical gasket may be at most 15% larger than the outer diameter at the ends of the cylindrical gasket. Since the gasket is made due to their functional effect of a flexible or elastic material and with the smallest possible wall thickness, the cylindrically shaped gasket has a slightly barrel-shaped at least in the undisturbed inflated state, in which the outer diameter at the two ends are smaller than that Usually in the middle of the barrel encountered largest outside diameter. The small deviation between the largest outer diameter and the frontal outer diameters also allows a uniform pressure distribution in the longitudinal direction of the gasket.
  • a preferred embodiment provides that the wall thickness of the gasket is between 0.08 mm and 0.12 mm.
  • a gasket made of a flexible material with such a small wall thickness inflates easily in the inspiration by the low intrinsic resistance and also falls easily in the expiration together again.
  • a variant provides that the distance between the lungsissertigen end of the gasket and the lungsracertigen end of the breathing tube is less than twice, preferably smaller than the simple outer diameter of the breathing tube.
  • a particular embodiment provides that the at least one ventilation cannula is arranged parallel to and / or integrated in the breathing tube at least in the part which can be inserted into the trachea.
  • Such a fixation of the ventilation cannula avoids the presence of mutually interfering lines or reduces the number of lines to be introduced into the trachea, so that both the intubation itself and the presence of a tracheal tube in the trachea is less stressful for the patient and avoids disturbing influences become.
  • the inner diameter of the at least one ventilation cannula can amount to at least 20%, preferably at least 25%, of the inner diameter of the breathing tube.
  • the internal diameter of the two or more ventilation cannulas is to be regarded as the inside diameter.
  • the inner diameter of the ventilation cannula can be greater than 1.5 mm, preferably greater than 2.0 mm. This absolute inner diameter of the ventilation cannula or equivalent diameter of several cannulas allows a reliable function of the sealing sleeve for conventional sizes of the breathing tube.
  • the length of the at least one ventilation cannula may be less than 1.2 times, preferably less than 1.1 times the total length of the breathing tube.
  • a small length of the vent cannula is important to minimize drag and thereby optimize inflation and collapse of the gasket.
  • constrictions and connections can have a negative effect on the flow resistance of the ventilation cannula and should therefore be avoided.
  • the present invention further relates to the use of a tracheal tube for ventilating patients by means of a pressure-controlled respirator, with a breathing tube, a sealing cuff and at least one ventilation cannula, for connection to a speech valve.
  • the respiratory tube is at least partially insertable into the trachea, wherein the gasket is arranged on the insertable into the trachea part around the breathing tube around.
  • the at least one ventilation cannula opens at one end into the gasket and at its distal end remote from the gasket in the breathing tube.
  • the jacket sealing surface of the sealing sleeve is larger than the lungs stiirtige annular end face of the gasket.
  • the at least one ventilation cannula is designed in such a way that, when the speech valve is connected to the breathing tube, it is guided past the speech valve and opens into the breathing tube on the side of the speech valve facing away from the gasket.
  • the gasket inflates and when inflated, it inflates Cladding sealing surface of the gasket to the trachea, wherein the shell sealing surface in the inflated state is greater than the lungs ⁇ rtige annular face of the gasket.
  • the gasket Upon expiration, the gasket at least partially collapses and releases a passageway between the trachea of the gasket, while the voice valve blocks backflow of the breathing air. This allows for at least partial oral expiration so that the breathing air bypasses the vocal cords and allows the intubated patient to speak.
  • a tracheal tube makes it possible to ventilate or pulsate the gasket in the rhythm of pressure-controlled ventilation, so that at least part of the respiratory flow is exhaled past the gasket when the respiratory gas is expired.
  • bronchial secretions may also be transported orally past the gasket.
  • the partial respiratory flow flowing past the vocal cords allows for voice production.
  • the gasket and the at least one ventilation cannula are optimally matched to one another and adapted to the use of the tracheal tube for ventilating patients by means of a pressure-controlled respirator, so that the pressure and the volume of the gasket build up quickly during inspiration To fill the patient's entire lung with respiratory gas, and rapidly degrade it during expiration, to direct the partial airflow past the gasket to transport bronchial secretions orally and to allow for vocal cord vocalization.
  • a tracheal tube 1 for endotracheal application is described in US Pat Fig. 1 shown in a side view.
  • the tracheal tube 1 comprises a flexible breathing tube 2, which is inserted in a known manner in the trachea (trachea) and is connected at its upper end to a pressure-controlled respirator (ventilator), not shown, which serves for the periodic introduction of respiratory gas into the lungs.
  • the breathing tube 2 is provided at its lungsskyskyigen, introduced into the trachea 3 end, with a gasket 4.
  • the cylinder or barrel-shaped gasket 4 is made of a thin elastic material and has a diameter of about 3 cm at a length of about 3.5 cm in an inflated but unstretched and unexpanded state. Because of the flexibility of the elastic material, the opposite end faces of the sealing sleeve have a minimally smaller diameter than the middle part of the sealing collar 4. In Fig. 1 a part of the gasket 4 is cut away, so that both the cylindrical shape, the thin wall thickness and the concern of the outer jacket sealing surface 5 on the wall of the trachea 3 is clearly visible.
  • the end faces 6 of the sealing sleeve 4 are airtightly connected by means of an extending in the direction of the breathing tube 2 supernatant 7 with the breathing tube 2, so that the inner surface of the hollow cylindrical gasket is formed by the outer wall of the breathing tube 2. Since the wall thickness of the gasket 4 is very small at about 0.1 mm both in the region of the supernatant 7 and the end faces 6 and the jacket sealing surface 5, also in the region of the supernatant 7 through the connection with the breathing tube 2 enlarged tube diameter are negligible.
  • the end face 6 of the sealing sleeve 4 is only approximately 1 cm away from the lungs stiirtigen end of the breathing tube 2, which corresponds approximately to the outer diameter of the breathing tube 2.
  • the gasket 4 is supplied by means of a ventilation cannula 8 with air from the breathing tube 2.
  • the ventilation cannula 8 extends in the insertable into the trachea 3 part of the breathing tube 2 within the wall of the breathing tube 2 and opens with its opening 9 in the gasket 4.
  • the connector 11 has in addition to the nozzle for the ventilation cannula 8 and a nozzle on the breathing tube 2 is arranged, and a connection end, with a pressure controlled respirator (not shown).
  • a suction cannula 12 extends into the subglottic region of the trachea 3 orally of the gasket 4. By means of this suction cannula 12 can sucked through the suction port 13 in the subglottic region secretions and other liquids from the trachea 3 become.
  • the aspiration cannula 12 can both be fixedly connected to the respiratory tube 2, or integrated therein, or introduced into the trachea 3 only parallel to the respiratory tube 2.
  • a further embodiment of a tracheal tube 1 according to the invention shows the Fig. 2 .
  • This tracheal tube 1 is designed for a tracheostomatic application and is not introduced orally but via a tracheostoma in the trachea 3 of a patient.
  • the structure and operation of the arranged at the lungsissertigen end of the breathing tube 2 gasket 4 corresponds to the above for the endotracheal tube 1 from Fig. 1
  • the arrangement of the ventilation cannula 8 to the breathing tube 2 and the opening 9 and the connection of the distal end 10 on the connector 11 with the endotracheal tube 1 from Fig. 1 identical construction described. Therefore, in the following, only the differences of the Tracheostomatisch used tracheal tube 1 from Fig. 2 received.
  • the suction cannula 12 is independent of the tracheal tube 1, which is introduced into the trachea 3 by a corresponding tracheostomy, and is supplied orally. In turn, secretion and other fluids from the subglottic area of the trachea 3 can be sucked out of the sealing collar 4 orally via the suction opening 13 of the suction cannula 12.
  • a winged cuff 14 is provided which can be displaced on the breathing tube 2 with resistance to the position of the breathing tube 2 in the trachea 3 and opposite to the respiratory tube 2 Fix the tracheostomy.
  • the breathing tube 2 in tracheostatic tubes is usually provided with a metal spiral which is embedded in the wall of the breathing tube 2.
  • a speaking valve 15 is provided, with which a return flow of the breathing air is prevented in the expiration, so that the exhaust air completely orally at the Sealing gasket 4 is exhaled by. Since all the breathing air flows past the vocal cords when exhaling, it is possible for the intubated patient to speak.
  • the voice valve 15 only allows inspiration air flowing to the lungs, while the voice valve 15 is blocked in the opposite direction.
  • Fig. 3 shows the arranged at the lungeischenrtigen end of the breathing tube 2 gasket 4 outside the trachea 3.
  • the cylindrical or slightly barrel-shaped shape of the gasket 4 can be seen clearly, the diameter d max in the middle of the gasket 4 (seen in the longitudinal direction) only slightly greater than the diameter d 1 of the end faces 6 is.
  • the respiratory gas or air from the pressure controlled respirator flows through the breathing tube into the patient's lungs, as in the Fig. 1 and 2 as well as 4 arrows.
  • the sealing sleeve 4 is filled with air via the ventilation cannula 8, so that the jacket sealing surface 5 rests against the wall of the trachea 3.
  • Almost all of the respiratory air generated by the ventilator flows into the patient's lungs. Only a very small part of the breathing air is used to inflate the gasket 4.
  • the ventilation cannula 8 is guided outside of the breathing tube 2. However, the ventilation cannula 8 continues to run parallel to the breathing tube and is firmly connected to the breathing tube 2 at least in the area of the sealing sleeve 4.
  • the pressure in the gasket 4 is reduced by the lack of pressure of the ventilator, whereby the pressure reduction in the cuff 4 is faster than in the lungs of the patient.
  • the respiratory air flows out of the lungs through the breathing tube 2 and assists the collapse of the sealing cuff 4 in which a negative pressure is generated at the inlet of the ventilation cannula 8 in the connection piece 11, thereby sucking air out of the sealing cuff.
  • the breathing air under pressure in the lungs presses against the lungs ⁇ rtige end face 6 of the gasket 4 and thus also supports the collapse or partial collapse of the gasket 4, as in Fig.
  • bronchial secretion 16 present in the trachea 3 in the lungsward direction of the sealing cuff 4 is transported orally in the expiration through the partial respiratory air flow passed by the sealing cuff 4. Since the cross-sectional area of the trachea 3 available for the respiratory air flow increases again especially in the case of tracheal tomcubes 4, the flow velocity of the respiratory air and thus also its ability to transport the secreting drops 16 entrained past the sealing sleeve 4 further orally are reduced. Therefore, bronchial secretion may accumulate in the subglottic region of the trachea 3 between the gasket 4 and the vocal cords and must be removed at least at regular intervals by a corresponding suction device (not shown).

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  • Health & Medical Sciences (AREA)
  • Pulmonology (AREA)
  • Emergency Medicine (AREA)
  • Engineering & Computer Science (AREA)
  • Anesthesiology (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Hematology (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)
  • External Artificial Organs (AREA)
  • Respiratory Apparatuses And Protective Means (AREA)

Claims (12)

  1. Tube trachéal (1) pour la respiration artificielle pratiquée sur des patients à l'aide d'un respirateur commandé par pression, avec un tuyau de respiration (2) qui est apte à être introduit au moins en partie dans la trachée (3), un manchon d'étanchéité (4) qui est disposé, au niveau de la partie apte à être introduite dans la trachée (3), autour du tuyau de respiration (2), au moins une canule d'aération (8) qui débouche dans le manchon d'étanchéité (4) et, avec son extrémité (10) opposée au manchon d'étanchéité (4), dans le tuyau de respiration (2), et un dispositif d'aspiration (12) qui est dirigé vers la bouche, à partir du manchon d'étanchéité (4), en vue d'une aspiration, étant précisé que la surface d'étanchéité latérale (5) du manchon (4) est plus grande que la surface frontale annulaire (6) du manchon (4) dirigée vers les poumons,
    caractérisé en ce qu'il est prévu une valve phonatoire (15), ladite valve phonatoire étant disposée au niveau de la partie du tube de respiration (2) qui n'est pas apte à être introduite dans la trachée (3), et la ou les canules d'aération (8) débouchant, du côté de la valve phonatoire (15) opposé au manchon d'étanchéité (4), dans le tuyau de respiration (2).
  2. Tube trachéal (1) selon la revendication 1, caractérisé en ce que la paroi intérieure du manchon d'étanchéité (4) disposé autour du tuyau de respiration (2) est appliquée entièrement contre le tuyau de respiration (2) ou est formée par le tuyau de respiration (2).
  3. Tube trachéal (1) selon la revendication 1 ou 2, caractérisé en ce que le volume du manchon d'étanchéité (4), entre le tuyau de respiration (2) et la surface latérale, est non divisé.
  4. Tube trachéal (1) selon l'une des revendications 1 à 3, caractérisé en ce que le manchon d'étanchéité (4), dans la partie apte à être introduite dans la trachée (3), est conçu pour être fermé par rapport au tuyau de respiration (2).
  5. Tube trachéal (1) selon l'une des revendications 1 à 4, caractérisé en ce que le manchon d'étanchéité (4) est cylindrique.
  6. Tube trachéal (1) selon la revendication 5, caractérisé en ce que le diamètre extérieur maximal dmaX du manchon d'étanchéité cylindrique (4), à l'état gonflé, est supérieur de 15 % au maximum au diamètre extérieur d1 aux extrémités du manchon d'étanchéité cylindrique (4).
  7. Tube trachéal (1) selon l'une des revendications 1 à 6, caractérisé en ce que l'épaisseur de paroi du manchon d'étanchéité (4) est située entre 0,08 mm et 0,12 mm.
  8. Tube trachéal (1) selon l'une des revendications 1 à 7, caractérisé en ce que la distance entre la surface frontale (6) du manchon d'étanchéité (4) située côté poumons et l'extrémité (10) du tuyau de respiration (2) située côté poumons est inférieure à deux fois, de préférence inférieure à une fois le diamètre extérieur du tuyau de respiration (2).
  9. Tube trachéal (1) selon l'une des revendications 1 à 8, caractérisé en ce que la ou les canules d'aération (8), au moins dans la partie apte à être introduite dans la trachée (3), sont disposées parallèlement au tuyau de respiration (2) et/ou sont intégrées dans celui-ci.
  10. Tube trachéal (1) selon l'une des revendications 1 à 9, caractérisé en ce que le diamètre intérieur de la ou des canules d'aération (8) représente au moins 20 %, de préférence au moins 25 % du diamètre intérieur du tuyau de respiration (2).
  11. Tube trachéal (1) selon l'une des revendications 1 à 10, caractérisé en ce que le diamètre intérieur de la canule d'aération (8) est supérieur à 1,5 mm, de préférence supérieur à 2,0 mm.
  12. Tube trachéal (1) selon l'une des revendications 1 à 11, caractérisé en ce que la longueur de la ou des canules d'aération (8) est inférieure à 1,2 fois, de préférence inférieure à 1,1 fois la longueur totale du tuyau de respiration (2).
EP09013244A 2008-10-21 2009-10-20 Tube trachéen Active EP2179761B1 (fr)

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
DE102008052438A DE102008052438A1 (de) 2008-10-21 2008-10-21 Trachealtubus

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EP2179761A1 EP2179761A1 (fr) 2010-04-28
EP2179761B1 true EP2179761B1 (fr) 2011-12-14

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Publication number Priority date Publication date Assignee Title
DE102011005248B4 (de) 2011-03-08 2016-03-10 Siemens Aktiengesellschaft Medizintechnische Verschlussvorrichtung
DE102016002841A1 (de) 2016-03-10 2017-09-14 Wolf & Riemann Patent GbR (vertretungsberechtigte Gesellschafter: Rosemarie Wolf, 37269 Eschwege; Rainer Wolf, 37269 Eschwege; Claudia Riemann, 37269 Eschwege) Trachealkanüle

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US3707151A (en) 1971-02-16 1972-12-26 Richard Robert Jackson Self-inflating endotracheal tube
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JP2003210585A (ja) * 2002-01-21 2003-07-29 Hiroaki Nomori 気管切開チューブ
CA2535900C (fr) * 2003-07-28 2013-06-04 Luiz Gonzaga Granja Filho Sonde a usage medical
US7686019B2 (en) * 2005-11-23 2010-03-30 Markus Weiss Auto-inflation cuffs

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DE102008052438A1 (de) 2010-04-22
ATE536903T1 (de) 2011-12-15

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